- Thank you for visiting this video segment for Dr. AFib.
I'm Dr. Morales.
In today's video segment, we're gonna be talking
about cardioversions and they can be helpful
for patients who have atrial fibrillation.
So first of all, what is a cardioversion?
A cardioversion is an electrical shock to your heart
to try to reset your heart
and get you out of atrial fibrillation.
You may have seen in TV and the movies
when somebody's heart stops and they take the paddles
and they paddle somebody and give 'em the electrical shock
to bring them back to life.
Cardioversion is pretty much exactly the same thing
except a lot less dramatic, as I tell my patients.
Basically, what happens is that you get electrical current
applied to your heart to reset your heart
and to try to bring you our of AFib
and back into normal rhythm.
I tell patients that it's kinda like when
either your telephone or your computer is not working
and you turn it off and you turn it back on again
to reset it,
same exact principle, same exact idea
in terms of what a cardioversion actually does.
Now, you may see YouTube videos
of somebody getting a cardioversion and it's very painful
and you see them jumping outta the chair,
and again, that's a very dramatic examples,
and in an emergency setting
where people need to get a cardioversion done
for usually something that's life threatening,
they don't always have the right amount of time
to actually give people proper sedation,
and it can be very painful.
However, when you get a cardioversion setup
with your doctor and it's set up as an appointment,
I always schedule mine with an anesthesiologist
so they make sure that you don't feel anything.
And so typically, you're getting
very strong sedation medication
which only lasts but for a few minutes.
Once you're deep into sleep,
we go ahead and do the shock treatment,
which these days, involves putting pads on your chest
in the front and as well as in the back
and applying that electrical current.
So why do a cardioversion?
What's the benefit of doing a cardioversion?
Well, the main benefit is
to get somebody out of atrial fibrillation,
and does a cardioversion work?
Does it actually get somebody out of atrial fibrillation?
So I usually tell my patients
that the cardioversion usually works.
In my experience, the actual shock treatment works
probably about 90% of the time
to actually get you out of atrial fibrillation.
Now, that doesn't mean the atrial fibrillation
can't come back.
There's an inherent short circuit problem
or a problem with your heart
which is triggering episodes of atrial fibrillation.
So the AFib may come back an hour later,
a week later, a year later, you know,
but the cardioversion typically works with most success rate
in that actual moment of time
to get you out of atrial fibrillation.
Usually, changes in medication are required
after the cardioversion in order to help keep you
in a normal rhythm.
So those are sorta the reasons how it helps
and why it may be beneficial.
This is only beneficial for people who are in
what's called persistent atrial fibrillation,
meaning you're in atrial fibrillation all the time.
If your AFib episodes come and go,
a cardioversion is not the right treatment for you,
but you're in AFib consistently,
it may be a beneficial treatment option for you.
However, I will say when it comes to the success rate
of a cardioversion, the longer somebody is in AFib,
the less likely the cardioversion will be successful.
As I've mentioned several times,
the more people are in atrial fibrillation,
the longer time goes by,
the heart inherently changes,
and then, it makes it much harder to stop
or cardiovert the atrial fibrillation.
So if somebody's been in AFib consistently
for a couple years, I usually don't even try a cardioversion
because the success rate can be pretty low.
But if you've been in AFib for several months
or even a year, it can be beneficial,
and it can be successful.
So again, how does a cardioversion work?
So it's typically scheduled as an appointment
with your doctor.
In my case, I always schedule it with an anesthesiologist.
You get a IV put in place.
Once everything is in position and ready,
you get heavy sedation medication,
which will only put you to sleep for only a few minutes,
and you're nice and asleep,
we apply this electrical current to your heart
to help reset your heart.
Typically only takes about about few seconds to do.
Once you're nice and awake,
it usually only takes about half an hour or so
from the sedation medication, typically, patients can home.
Again, I typically require medication adjustments
after cardioversion in order to improve the success rate.
When it comes to the cardioversion shock,
there's different ways to actually deliver that shock.
There's different levels of energy.
There's very low amounts, and there's higher amounts,
and people, dependent on their size,
the larger people, people who are more overweight
are gonna require higher energy
because you just have to get through more tissue
to actually try to reset your heart.
So this can be a very useful treatment strategy
for a lot of patients.
So when do I recommend cardioversions to my patients?
One would be when they have symptoms
and they need something done very quickly.
If I see patients in my office
and they are very short of breath or very tired,
I will do a cardioversion on them quickly
because that's probably the most rapid thing
that I could offer to them.
I could offer them cardioversion either the same day
or the next day to help get them out of AFib
and improve their symptoms.
Longterm, other options, such as an ablation,
may work better, but in the short-term, quick fix,
cardioversion can be a very useful treatment option.
Another way in which a cardioversion
may be a useful treatment option is if
for people who have very subtle symptoms
and you don't really know if it's the AFib or not.
If you have AFib and you're consistently in AFib
and you feel tired or run down or short of breath
but all your numbers look okay,
the heart rate is okay, the heart function is okay,
but it's not really clear if it's the AFib itself
causing some of these additional subtle symptoms,
the only way to know for sure is a bit of trial and error,
and that is to get you out of atrial fibrillation.
And in these type of people,
I typically would give a trial of cardioversion
to see if it actually is helpful,
can we get you out of AFib,
does it change anything about how you feel?
Now, what are the risks of a cardioversion?
Cardioversion is a usually pretty straightforward procedure.
It's a procedure that I tend to do first
on people who I think are too sick
or have too many medical conditions
to undergo more aggressive treatment options
like an ablation.
So it is a treatment of choice.
Although it sounds pretty dramatic
to have a shock done to your heart,
it's actually much more benign compared
to other treatments and other procedures
that are done for atrial fibrillation.
So what are the main risks involved?
The main risks involved are doing it
if you have a blood clot inside of your heart
because that blood clot, if you apply a shock,
may potentially dislodge
and can give people a risk for stroke.
So there's a few ways to mitigate that risk of blood clot
and that risk of stroke during a cardioversion.
One, if somebody's on blood thinners consistently,
if I have my patients on blood thinners consistently
for over two months, the chances of having a blood clot
are very low, and usually we can proceed straight
with the the cardioversion.
But for people who do not take strong blood thinners
or they have not been on strong blood thinners
for very long, I usually check them for a blood clot
with what's called a transesophageal echo.
I usually do it together all at the same time.
When they're asleep, I put a tube about the size
of my finger down your mouth and into your esophagus,
and that takes very clear pictures of your heart
just to make sure there is no signs of a blood clot.
Provided that that's clear,
right then and there, we do the cardioversion
and get the person back into a normal rhythm.
So that's how we mitigate sorta the main risk.
I do have patients who have asked me what happens
if you restart your heart and it doesn't wanna come back
or it comes back too slow?
Fortunately, I have not seen that happen.
The heart is very resilient, and it comes back.
There are times it can be very slow after a cardioversion
and require a decrease in medications.
There's actually only been one time
in the hundreds of cardioversions that I've done
where patient was so slow,
I ended up needing to have to put a pacemaker afterwards,
but that is very, very rare.
Usually, the heart rate is perfectly acceptable
after a cardioversion, but again,
it does require some medication adjustments.
But for many people,
a cardioversion can be a very successful treatment option
to provide rapid relief for symptoms
from atrial fibrillation,
and it's not nearly as dramatic as the videos
that you see on YouTube
when done in a nice controlled setting
and the pain is controlled adequately
and you're sedation's controlled adequately.
Thank you for visiting this video segment for Dr. AFib.
I'll see ya next time.